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…In the School of Hard Knocks

Because right now I’m doing a lot of insurance related things I thought I’d share some “tips” drawn from my own experiences.

Disclaimer: EVERYBODY is different. I believe these tips to apply to most people but you need to double check when applying them to your own situation.

None of this stuff is new, there are tons of sites out on the Interwebz that can tell you this stuff…

HOWEVER… whatcha get here is proof that those “tips” — well these “tips” actually do produce results. I’ve “been there” and “done that” and have the battle scars to prove it.

So, hopefully my experience can help you minimize the pain of dealing with insurance companies whose primary goal is to make money.

You gotta know the rules

My personal experience has shown me that “Insurance companies are NOT your friends“. Insurance companies are not there to make you healthy or to get you healthy.

They are there to make money. They are a BUSINESS and the less that you use your insurance, the MORE money they make.

Which seems counter productive from the view point of us folks who NEED the medical services. The insurance company will say “NO” unless they are required by law or by contract to say “yes”.

Don’t misunderstand me — I am not advocating that you try to stick it to the insurance companies and rack up unneeded medical costs. That is called “fraud” and will get you in trouble. But what I am saying is that if you and your doctor think you need it then make the insurance company do EVERYTHING it is obligated to do.

Insurance companies are restricted by laws and by the contract to which you agree when you buy the policy. But they are counting on your ignorance to not utilize all of your benefits.

And they do NOT make it easy to figure out exactly what you can get. sigh

To protect yourself, you will need two VERY IMPORTANT DOCUMENTS:

Your Policy Handbook — This is your contract with your insurance company. It has TONS of information about your benefits under the policy and sometimes has forms and/or procedural information. Often, near the front is a “summary chart” that gives you the basics of your policy including Out of Pocket Maximums, Copay information for doctors and drugs

Your Drug Formulary — This is a list of the drugs which are covered or not covered under your policy and the level at which they are covered. Prices and coverage vary from plan to plan even within the same company. (see the above disclaimer)

Often these are available online either as a webpage or as a PDF file. The Drug Formulary is often available as a searchable interface online.